Archive for 'Hot Coding Topics'

The way your coding progresses in case of foreign body removal (FBR) will be dictated mainly by whether your gastroenterologist decides to removethe foreign body or simply moves it. Just follow these tips to stay abreast of the procedure codes.

Background: Although ingestion of foreign bodies is a most common occurrence in the young to very young populace, it is not rare in adults. It usually occurs accidentally but can result from deliberate ingestion. Patients with mental illness, intellectual impairment, prisoners or ‘drug-carriers,’ ‘body-packers’ (people smuggling illicit drugs concealed in their gastrointestinal tract) are prone to problems caused by purposeful ingestion of foreign bodies. Trichobezoar is a rare condition where hair ingestion leads to formation of a hairball in the stomach.

The July 2014 CPT® Assistant is brimming with updates made to the CPT® 2014 Medicine/Cardiovascular section. Find out how the introduction of several new codes in the cardiovascular section has affected the reporting of various services. You’ll increase your understanding of the changes created by revisions to codes for implantable and wearable cardiac device evaluations, injection procedures, and cardiac catheterization.

Other areas featured in the July 2014 CPT® Assistant include insights about code 92626, Evaluation of auditory rehabilitation status, and conventions of ICD-10-CM.You can use SuperCoder.com’s Code Connect code and keyword search to update your skills on the following topics:

The June 2014 CPT® Assistant guides you through the implementation of CPT®category III adaptive behavior assessment and treatment codes and guidelines on July 1, 2014. You’ll come across a list of guiding principles that led to the development of assessment and treatment codes by a panel of members representing psychiatry, clinical social workers, behavioral analysts, payers, and many more to help you better understand and apply these codes. Be sure you don’t miss out on the assessment codes that enable the provider to identify adaptive behavior treatment and developing a plan of care.

Other areas featured in the June 2014 CPT® Assistant include active wound care management through low frequency ultrasound and conventions of ICD-10-CM. You can use SuperCoder.com’s Code Connect code and keyword search to update your skills on the following topics:

Training your staff members about ICD-10 codes and updating your software to handle the new diagnoses is a great start to your ICD-10 transition plan, but the job isn’t completed just yet. There are a few additional steps that you’ll need to take between now and the new implementation date, experts said during CMS’s March 13 webinar, “ICD-10 Overview: Basics and Transition Tips.

When a problem is found during a well visit, you may need to charge patients who expect to pay nothing.

As you are well aware by now, the Patient Protection and Affordable Care Act (PPACA) that became law in 2010 requires you to provide preventive care visits consistent with Bright Futures Guidelines for children at no cost to the patient or family, including well child exams, vision and hearing screening, immunizations, and obesity counseling, among other services.

These visits are not subject to a copay, coinsurance or deductible, so patients who schedule them come to your practice expecting to leave without paying any money out of their pockets. However, (more…)

If your patient’s Pap smear results return as abnormal or display insufficient cells, the ob-gyn will probably perform a repeat smear. Use proper E/M coding to get the payment you deserve.

Zoom In on Your Visit Code

When the patient comes in for a second Pap smear, submit the appropriate E/M service. CPT® does not include a code for taking the Pap, so you should use the office visit code (99211-99215).

You will probably report 99212 for the Pap retest visit because the patient is here only for the Pap smear.

That translates to almost $45 per visit, using the Medicare Physician Fee Schedule national rate. Code 99212 (Office or other outpatient visit for the evaluation and management of an established patient …) carries 1.22 relative value units (1.22 RVUs x 2008 conversion factor 35.8228 = $43.70).

The May 2014 CPT® Assistant starts off with a bang, featuring a 2014 code update article for four surgical areas: integumentary, respiratory, digestive, and urinary. Need to know what to do when the physician gets a specimen mammogram to verify calcification before the specimen heads to pathology? Want to be sure you’re reporting same-side pleural drainage and pleural catheter insertion correctly? See what the latest CPT® Assistant has to say.

You’ll find other 2014 updates in the May CPT® Assistant, too. You’ll also be able to prepare for coding beyond 2014 with helpful hints for ICD-10. Finding these articles is as simple as searching SuperCoder.com’s Code Connect by code and keyword:

Reporting the radiofrequency (RF) ablation procedures in the spinal areas can be challenging if you do not pay attention to details. Remember, the RF ablation differs from spinal injections. Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co. shares useful tips for spinal RF ablation procedures that can help you to always submit compliant codes.

Change Your Focus from Nerves to Joints

In the past, you coded for destructive procedures based on each individual nerve, as opposed to diagnostic/therapeutic injections that are based on the facet joint level. But that changed when new codes for paravertebral facet joint destruction became effective in 2012.

“At that point the ‘counting’ methodology changed to be similar to the injection codes,” Hammer says.

Official word comes from Medicare on stance, despite AAO-HNS objections.

Otolaryngologists and physicians in some other specialties (such as family practice) have fought since early 2014 to gain bilateral payment for the removal of impacted cerumen, based on the CPT® 2014 manual’s description of service. Read on for the latest roadblock to that type of filing.

Background: In previous years, the descriptor for 69210 read as “Removal impacted cerumen (separate procedure), 1 or both ears.” That changed this year, with a revised descriptor stating “Removal impacted cerumen requiring instrumentation, unilateral.” CPT® 2014 also includes a coding note directing you to append modifier 50 for bilateral procedures.

The issue: When physicians began submitting claims with 69210-50 for bilateral procedures, some received denials because of the modifier. The primary payer refusing to acknowledge a bilateral designation for 69210 was Medicare, but some private payers followed suit.

The reaction: The American Academy of Otolaryngologists – Head and Neck Surgeons (AAO-HNS) submitted letters to several payers about their policies that deny claims with 69210 is billed in conjunction with and office-based E/M code (99211-99215). The Academy also held a conference call with CMS on the matter, as noted previously in Otolaryngology Coding Alert (see “Watch for inconsistencies with 69210 payment before filing your claims,” Vol. 16, N. 3). CMS stance at that time was that the payment policy within the 2014 final Medicare Physician Fee Schedule would stand – no recognition of modifier 50 when filed with 69210.

Scenario: An established patient reports to your office with pain, swelling, and tenderness of the left wrist and forearm. The physician diagnoses the patient with a buckle fracture of the wrist, which he stabilizes with a splint before sending the patient home. The patient returns four weeks later and the physician takes two follow-up x-rays of the patient’s forearm.

Bill Those Follow-Up X-Rays

The challenge: You should report fracture care (25600, Closed treatment of distal radial fracture [e.g., Colles or Smith type] or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation) and any x-rays performed for the initial visit. But can you report the follow-up x-rays?